The prevalence of the use of marijuana throughout the world is substantial. In light of ongoing increases in accessibility to marijuana, safety and efficacy must be established to guide recommendations for safe use. Of particular interest is at-risk populations such as persons living with HIV (PLWH) in whom there are higher rates of marijuana use and inherent risks of comorbid conditions. Databases and reference lists were searched for relevant studies investigating marijuana or cannabinoid use, HIV, and/or pulmonary diseases. The effect of marijuana on the human body is complex and not yet fully understood. The principal components, tetrahydrocannabinol, and cannabidiol interact with cannabinoid receptors. As some cannabinoid receptors are located in the immune system, many have investigated the effect of marijuana on the immune system. Although marijuana would appear to have anti-inflammatory properties, there are conflicting findings on its immune effect in PLWH. In the lung, marijuana smoke is thought to cause harm. Marijuana smokers have shown increased rates of respiratory symptoms, and a variety of changes on lung function has been reported. Limited data are available specific to the safety of marijuana on the lung, cognition, malignancy risk, and cardiovascular disease in PLWH who are already at increased risk of chronic diseases. Marijuana use is common in PLWH, but significant research gaps exist with regard to its safety and efficacy. Until further evidence on its safety is available, recommendations should be to avoid the use in PLWH.
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